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Musculoskelet Sci Pract. 2019 Nov 10;46:102069. doi: 10.1016/j.msksp.2019.102069. [Epub ahead of print]

Comparing the range of musculoskeletal therapies applied by physical therapists with postgraduate qualifications in manual therapy in patients with non-specific neck pain with international guidelines and recommendations: An observational study.

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SOMT University of Physiotherapy, Amersfoort, the Netherlands; Erasmus University, Rotterdam, the Netherlands. Electronic address:
Rotterdam University of Applied Sciences, Rotterdam, the Netherlands.
Erasmus University, Rotterdam, the Netherlands.
MOVE Research Institute, VU University Amsterdam, Amsterdam, the Netherlands.
Erasmus University, Rotterdam, the Netherlands; Avans Hogeschool, Breda, the Netherlands.
Erasmus University, Rotterdam, the Netherlands; Center for Muscle and Joint Health, University of Southern Denmark Odense, Denmark.


The aim of this study is to compare Dutch usual care musculoskeletal therapy in patients with non-specific neck pain with recommendations from international clinical practice guidelines. Physical therapy is diverse, as it may consist of exercise, massage, advice, and other modalities. Physical therapists with post graduate qualifications in manual therapy (MT) may additionally apply spinal thrust manipulation or non-thrust mobilization techniques to treat neck pain. It is important that, in the absence of a Dutch clinical guideline for the treatment of patients with neck pain, musculoskeletal therapists use the available recommendations from international clinical practice guidelines when treating patients with neck pain. One updated clinical practice guideline was identified (Blanpied, 2017), a report from the Task Force on Neck Pain (Guzman et al., 2008) and the IFOMPT International Framework for Examination of the Cervical Region for potential of Cervical Arterial Dysfunction prior to Orthopaedic Manual Therapy Intervention (Rushton et al., 2014). At baseline 1193 patients are included and data with regard to pain, disability, fear avoidance, expectations and applied treatment modalities are gathered. Outcome is measured using the Global Perceived Effect questionnaire. Results show that patients with acute neck pain are treated significantly more often with manipulation compared to patients with sub-acute or chronic neck pain (p < .000) and younger patients are treated with manipulation more often than older patients (p < .000). In the presence of comorbidity, the preference of spinal manipulation seems to diminish, in favour of mobilization and exercise. Almost every patient receives multimodal therapy (94.3%) and spinal manipulation and mobilization are rarely used as a stand-alone treatment (4.5% and 0.8%). Dutch musculoskeletal therapists choose treatment strategies that correspond with recommendations from international guidelines.


Guidelines; Musculoskeletal therapy treatment; Neck pain; Spinal manipulations; Usual care

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